Today’s issue of WorkCompRecap features the California DIR & DWC’s release of the annual report for the Department’s Independent Medical Review (IMR) program, which covers IMR program activity in 2021, the eighth year since the program was implemented.
The DIR noted that program administrator, Maximus Federal Services, received 178,927 IMR applications (2.8% lower than 2020), and issued 133,400 Final Determination Letters (2.4% fewer), each addressing one or more medical necessity disputes. Other highlights included that pharmaceutical requests accounted for 31% of all treatment requests sent for IMR, a smaller proportion of total service requests than in previous years (34% in 2020, 42% in 2018), and opioids comprised 27% of all pharmaceutical requests. Treatment request denials were overturned at a rate of 7.2%, lower than the rate of 9.5% for 2020.